Coping strategies and collective efficacy as mediators between stress appraisal and quality of life among rescue workers.

Fire-fighters, paramedics, and emergency medical technicians routinely confront potentially traumatic events in the course of their jobs. The mediation role of coping strategies and collective efficacy in the relationship between stress appraisal and quality of life was examined (compassion satisfaction, compassion fatigue, and burnout) in a correlational study. Participants were 463 Italian rescue workers (fire fighters and different categories of emergency health care professionals). Participants filled out measures of stress appraisal, collective efficacy, coping strategies, and quality of life. The results showed that emotion and support coping, self-blame coping, and self-distraction mediated the relationship between stress appraisal and compassion fatigue. Moreover, collective efficacy, self-blame coping, and religious coping mediated the relationship between stress appraisal and burnout. Finally, collective efficacy, self-blame coping, and problem-focused coping mediated the relationship between stress appraisal and compassion satisfaction. Cognitive restructuring and denial did not mediate the relation between stress appraisal and any of the quality of life dimensions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Treating traumatized OEF/OIF veterans: How does trauma treatment affect the clinician?

[Correction Notice: An erratum for this article was reported in Vol 42(3) of Professional Psychology: Research and Practice (see record 2011-11548-008). The word “While” was erroneously inserted in the first sentence of the “Clinician Factors” section. The correct sentence is stated in the correction.] The authors of this article describe the rewards and challenges for clinicians treating veterans who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Issues of vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout are defined and reviewed, as are compassion satisfaction and posttraumatic growth. Patient, clinician, and organizational characteristics that are likely to affect clinicians working with this clinical population are discussed. Patient factors that may increase strain on clinicians are discussed such as age, likelihood of redeployment, comorbid conditions, attendance issues, and elevated risk for suicide and aggression. Clinician factors, such as theoretical orientation, training, supervision, military affiliation, personal trauma history, spirituality, social support, and self-care, are also discussed as possible risk and protective factors for vicarious trauma and burnout. Organizational influences, such as caseload size and diversity, clinician control and autonomy, use of evidence-based practices, availability of resources, rural isolation, and the philosophy of the clinic, are further discussed. Recommendations for ameliorating risks are discussed relative to each area and include allowing clinicians to plan their own appointments so as to balance their caseload of OEF/OIF veterans, attending to self-care practices, and having a supportive team with thorough training in evidence-based practices. Future empirical research is needed on risk and resiliency factors for clinicians working with traumatized OEF/OIF veterans given that this population is likely to grow. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"Treating traumatized OEF/OIF veterans: How does trauma treament affect the clinician?": Correction to Voss Horrell et al. (2011).

Reports an error in "Treating traumatized OEF/OIF veterans: How does trauma treatment affect the clinician" by Sarah C. Voss Horrell, Dana R. Holohan, Lea M. Didion and G. Todd Vance (Professional Psychology: Research and Practice, 2011[Feb], Vol 42[1], 79-86). The word “While” was erroneously inserted in the first sentence of the “Clinician Factors” section. The corrected sentence is provided in the erratum. (The following abstract of the original article appeared in record 2011-04544-011.) The authors of this article describe the rewards and challenges for clinicians treating veterans who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Issues of vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout are defined and reviewed, as are compassion satisfaction and posttraumatic growth. Patient, clinician, and organizational characteristics that are likely to affect clinicians working with this clinical population are discussed. Patient factors that may increase strain on clinicians are discussed such as age, likelihood of redeployment, comorbid conditions, attendance issues, and elevated risk for suicide and aggression. Clinician factors, such as theoretical orientation, training, supervision, military affiliation, personal trauma history, spirituality, social support, and self-care, are also discussed as possible risk and protective factors for vicarious trauma and burnout. Organizational influences, such as caseload size and diversity, clinician control and autonomy, use of evidence-based practices, availability of resources, rural isolation, and the philosophy of the clinic, are further discussed. Recommendations for ameliorating risks are discussed relative to each area and include allowing clinicians to plan their own appointments so as to balance their caseload of OEF/OIF veterans, attending to self-care practices, and having a supportive team with thorough training in evidence-based practices. Future empirical research is needed on risk and resiliency factors for clinicians working with traumatized OEF/OIF veterans given that this population is likely to grow. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Critical incidents and chronic stressors at work: Their impact on forensic doctors.

Workers in medium- or high-risk professions are often confronted with critical incidents at the workplace. The impact of these acute stressors may be serious and enduring. Many workers also experience chronic job stressors, such as work overload or role conflicts. This study examined the frequently neglected relationship of acute and chronic stressors with self-reported health symptoms, such as posttraumatic responses, fatigue, and burnout. This association was investigated in a sample of forensic doctors in the Netherlands (N = 84). It was found that the more traumatic events the respondents experienced, the more problems they reported in coping with the traumatic events. Chronic job stressors were associated with posttraumatic responses (intrusions and avoidances) and with burnout and fatigue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Type D personality and the development of PTSD symptoms: A prospective study.

Psychological trauma and prolonged stress may cause mental disorders such as posttraumatic stress disorder (PTSD). Pretrauma personality is an important determinant of posttraumatic adjustment. Specifically, trait neuroticism has been identified as a risk factor for PTSD. Additionally, the combination of high negative affectivity or neuroticism with marked social inhibition or introversion, also called Type D personality (Denollet, 2000), may compose a risk factor for PTSD. There is no research available that examined pretrauma Type D personality in relation to PTSD. The present study examined the predictive validity of the Type D personality construct in a sample of Dutch soldiers. Data were collected prior to and 6 months after military deployment to Afghanistan. Separate multiple regression analyses were performed to examine the predictive validity of Type D personality. First, Type D personality was defined as the interaction between negative affect and social inhibition (Na × Si). In a second analysis, Type D was defined following cutoff criteria recommended by Denollet (2000). Results showed that negative affectivity was a significant predictor of PTSD symptoms. Social inhibition and the interaction Na × Si did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, negative affectivity, and prior psychological symptoms. A second analysis showed that Type D personality (dichotomous) did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, and prior psychological symptoms. Therefore, Type D personality appears to be of limited value to explain development of combat-related PTSD symptoms. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The phenomenon of compassion fatigue in perioperative nursing

Compassion fatigue is described as the emotional burden that health care providers may experience as a result of overexposure to a traumatic event that has befallen victims. Perioperative nurses are experiencing increased exposure to major traumatic events within their practice, especially those nurses who work in level 1 trauma centers. This article helps nurses identify risks for compassion fatigue and symptoms associated with this form of stress.     

Community violence exposure, adverse childhood experiences, and posttraumatic distress among urban development workers.

The current study examines community violence exposure among 284 urban community development workers located in five U.S. cities. Adulthood exposure to community violence, history of adverse childhood experiences (ACEs), and current symptoms of posttraumatic distress (PTSD) were assessed to test the hypothesis that a personal history of ACEs moderates the relationship between community violence exposure and PTSD symptom severity. Seventy-five percent of urban development workers reported direct community violence victimization, 71% reported a history of at least one ACE, and 14% of the sample met probable diagnostic criteria for PTSD. A multiple regression analysis confirmed that ACEs and indirect adulthood community violence exposure were significantly positively related to the severity of PTSD symptoms. These variables accounted for a small amount of variance in PTSD. Direct exposure to community violence and the interaction between ACEs and community violence did not contribute significant variance to the model. The implications and limitations are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Gender differences in posttraumatic stress disorder.

One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peritraumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military veterans.

Differences in symptoms, trauma exposure, dissociative and emotional reactions to trauma, and subsequent life stress in war veterans reporting immediate-onset or delayed-onset posttraumatic stress disorder (PTSD) or no PTSD were investigated. The role of life stress in delayed-onset PTSD was also studied. Retrospective interviews were conducted with 142 United Kingdom veterans receiving a war pension for PTSD or physical disability. Immediate-onset and delayed-onset PTSD were similar in the number and type of symptoms reported at onset, but the delayed-onset group differed in showing a gradual accumulation of symptoms that began earlier and continued throughout their military career. They were more likely to report major depressive disorder and alcohol abuse prior to PTSD onset. Both groups described similar amounts of trauma exposure, but those in the delayed-onset group reported significantly less peritraumatic dissociation, anger, and shame. Veterans with delayed onsets were more likely than veterans with no PTSD to report the presence of a severe life stressor in the year before onset. In conclusion, the results suggest that delayed onsets involve a more general stress sensitivity and a progressive failure to adapt to continued stress exposure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological trauma and schizotypal personality disorder.

Two studies examined the relation between psychological trauma and schizotypal symptoms. In Study 1, in which 1,510 adults completed telephone interviews, both childhood maltreatment and the experience of an injury or life-threatening event were significantly associated with schizotypal symptoms. In Study 2, in which 303 adults (oversampled for having elevated levels of schizotypal symptoms) completed extensive in-person assessments, both childhood maltreatment and meeting posttraumatic stress disorder (PTSD) Criterion A were significantly associated with schizotypal symptoms. The links between schizotypal symptoms and at least some forms of psychological trauma could not be fully accounted for by shared variance with antisocial and borderline personality disorders, absorption/dissociation, PTSD symptom severity, family history of psychotic disorder, or signs of neurodevelopmental disturbance (as indexed by minor physical anomalies and inconsistent hand use). Schizotypal symptoms were more strongly associated with childhood maltreatment among men than among women, whereas schizotypal symptoms were more strongly associated with PTSD Criterion A among women than among men. Finally, among men, the association between childhood maltreatment and schizotypal symptoms was moderated by signs of neurodevelopmental disturbance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality, negative social interactions, and depressive symptoms.

Examined the associations among the frequency of negative social interactions, personality traits, and depressive symptoms in university students. 176 Ss completed measures of negative social interactions, sociotropy, autonomy, perfectionism, and depressive symptoms. It was found in the total sample that higher depression symptoms scores were correlated significantly with the frequency of negative social interactions, sociotropy, autonomy, and socially prescribed perfectionism. Additional results indicate that the frequency of negative social interactions accounted for unique variance in depressive symptoms over and above the variance predicted by personality traits, but it did not interact with these personality traits to predict unique variance in depressive symptoms. It was also found that the reported frequency of negative social interactions was correlated positively with socially prescribed perfectionism, sociotropy, and autonomy, especially among women. The current findings are discussed in terms of their implications for specific vulnerability and stress generation models of personality, life events, and depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring exposure to racism: Development and validation of a Race-Related Stressor Scale (RRSS) for Asian American Vietnam veterans.

This article describes the development and validation of the Race-Related Stressor Scale (RRSS), a questionnaire that assesses exposure to race-related stressors in the military and war zone. Validated on a sample of 300 Asian American Vietnam veterans, the RRSS has high internal consistency and adequate temporal stability. Hierarchical regression analyses revealed that exposure to race-related stressors accounted for a significant proportion of the variance in posttraumatic stress disorder (PTSD) symptoms and general psychiatric symptoms, over and above (by 20% and 19%, respectively) that accounted for by combat exposure and military rank. The RRSS appears to be a psychometrically sound measure of exposure to race-related stressors for this population. Race-related stressors as measured by the RRSS appear to contribute uniquely and substantially to PTSD symptoms and generalized psychiatric distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure therapy renewed.

Recurrence of posttraumatic stress disorder (PTSD) symptoms after treatment has been a long-standing problem. Recent theories of PTSD suggest that different types of processing (i.e., sensory vs. conceptual) may contribute to the return of symptoms. Patients who process their experience primarily via sensory cues (i.e., focusing on the specific environmental cues present at the time of the trauma) are more likely to develop the automatic, physiologically based symptoms of PTSD, which are often the most debilitating. Exposure therapy, based on conditioning principles related to extinction, may be a first-line course of treatment. Contemporary learning theory suggests ways to change exposure treatment to limit the reappearance of symptoms. This research suggests that lengthy and numerous exposure sessions, the use of conditioned inhibitors, and creating a maximal excitatory exposure context can yield efficacious treatment and minimize the likelihood of symptom renewal. Moreover, means for constructing the optimal exposure context are discussed via the use of free association. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Burnout and coping in human service practitioners.

Do many Spanish human service practitioners suffer from burnout? What coping strategies are used to combat work stress, and are they associated with lower burnout? Which strategies may the psychologist promote to improve organizations? With an eye toward helping organizations improve their workers' quality of work life and service delivery, 211 professionals, either child protection workers or in-home caregivers, completed an inventory on coping and another on burnout. Coping strategies alone do not preclude burnout but may help prevent worker turnover. High job and salary satisfaction, together with active coping strategies play an important role in promoting personal accomplishment. Low job and salary satisfaction and the use of passive or emotional strategies predict elevated emotional exhaustion. The results suggest some possible points of intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of initial trauma exposure on the symptomatic response to a subsequent trauma.

The effect of initial trauma on the symptomatic response to a subsequent trauma was investigated in a cross-sectional study of urban bus drivers. Comparisons were made among 175 drivers (mean age 42.2 yrs) who had developed either high or low symptoms of posttraumatic stress disorder (PTSD) as a result of the initial trauma, and a third group exposed to only a single trauma. The group with high levels Of PTSD symptoms after the initial trauma reported high PTSD symptoms for a subsequent trauma (75%) significantly more often than the other two groups who did not differ from each other (Low PTSD symptoms group 49%, No prior trauma group 41 %). These results suggest that unless trauma exposure leads to significant PTSD symptoms, it is not a risk factor for high PTSD symptoms after exposure to a subsequent traumatic event. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validating female psychopathy subtypes: Differences in personality, antisocial and violent behavior, substance abuse, trauma, and mental health.

Recent empirical investigations utilizing male prisoners have begun to validate clinical conceptualizations of primary and secondary psychopathy subtypes. We extended this literature by identifying similar psychopathic subtypes in female prisoners on the basis of personality structure using model-based cluster analysis. Secondary psychopaths (n = 39) were characterized by personality traits of negative emotionality and low behavioral constraint, an early onset of antisocial and criminal behavior, greater substance use and abuse, more violent behavior and institutional misconduct, and more mental health problems, including symptoms of posttraumatic stress disorder and suicide attempts. Primary psychopaths (n = 31) exhibited few distinguishing personality features but were prolific criminals especially in regards to nonviolent crime, and exhibited relatively few mental health problems despite substantial exposure to traumatic events. The results support alternative etiological pathways to antisocial and criminal behavior that are evident in personality structure as well as gender similarities and differences in the manifestation of psychopathic personalities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of childhood sexual trauma in the etiology of borderline personality disorder: Considerations for diagnosis and treatment.

Highlights recent research findings that demonstrate a connection between severity and type of sexual abuse and presentation of borderline-like symptoms. Similarities are drawn between the type of symptoms that make up a posttraumatic stress disorder (PTSD) diagnosis, and those that compose borderline personality disorder (BPD). Neither the PTSD nor BPD diagnoses are completely adequate to address the conditions of psychiatric patients with sexual abuse histories. In PTSD, characterological dysfunction in response to severe abuse experiences is not represented in the diagnosis, while BPD attributes symptoms solely to characterological dysfunction without recognizing their adaptive nature in the face of childhood trauma. A more accurate and less stigmatizing diagnostic category for survivors of sexual abuse has a significant role in expanding the possibilities for successful treatment of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vicarious traumatization, spirituality, and the treatment of sexual abuse survivors: A national survey of women psychotherapists.

Should psychotherapists limit their clinical work with trauma survivors to avoid being traumatized themselves? Vicarious traumatization (VT—the symptoms similar to posttraumatic stress disorder and the disruption in cognitive schemas reported in clinicians who are exposed to the trauma material of their clients—was assessed in a national survey of 1,000 women psychotherapists. Therapists with higher levels of exposure to sexual abuse material reported significantly more trauma symptoms but no significant disruption of cognitive schemas. Spiritual well-being, a key area thought to be damaged by VT, was found to be higher for those clinicians who saw more sexual abuse survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans

OBJECTIVE: The aim of this study was to determine the reliability and validity of a proposed measure of peritraumatic dissociation and, as part of that effort, to determine the relationship between dissociative experiences during disturbing combat trauma and the subsequent development of posttraumatic stress disorder (PTSD). METHOD: A total of 251 male Vietnam theater veterans from the Clinical Examination Component of the National Vietnam Veterans Readjustment Study were examined to determine the relationship of war zone stress exposure, retrospective reports of dissociation during the most disturbing combat trauma events, and general dissociative tendencies with PTSD case determination. RESULTS: The total score on the Peritraumatic Dissociation Experiences Questionnaire--Rater Version was strongly associated with level of posttraumatic stress symptoms, level of stress exposure, and general dissociative tendencies and weakly associated with general psychopathology scales from the MMPI-2. Logistic regression analyses supported the incremental value of dissociation during trauma, over and above the contributions of level of war zone stress exposure and general dissociative tendencies, in accounting for PTSD case determination. CONCLUSIONS: These results provide support for the reliability and validity of the Peritraumatic Dissociation Experiences Questionnaire--Rater Version and for a trauma-dissociation linkage hypothesis: the greater the dissociation during traumatic stress exposure, the greater the likelihood of meeting criteria for current PTSD.